Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 15653 | SC |
Y | 2080P0210X | Pediatric Nephrologist | 15653 | SC |
NPI | 1639109903 |
---|---|
Provider Name | Dr. Robert Carter Holleman JR. |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-6860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 21/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
156538 | (05) | SC |
G67649 | (02) |